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FORT WAYNE PRIMARY CARE LLC
NPI 1528707619
Internal Medicine in Fort Wayne, IN

Active since May 27, 2022CLIA 15D2268801 · Waiver
7802 W JEFFERSON BLVD STE A, FORT WAYNE, IN 46804(260) 999-6924(260) 222-2844 Get Directions Write a Review

NPPES record last updated: May 27, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Fort Wayne Primary Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FORT WAYNE PRIMARY CARE LLC (NPI 1528707619) is a healthcare organization registered as an internal medicine in Fort Wayne, Indiana and active in the NPI registry since May 2022. The organization holds a CLIA Waiver certificate valid through September 15, 2026 and lists Vishaal Veerula, Owner, as its authorized official.

NPPES Registry Identity

NPI1528707619
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameFORT WAYNE PRIMARY CARE LLC
Location Address7802 W JEFFERSON BLVD STE AFort Wayne, IN 46804-4138
Mailing Address7802 W Jefferson Blvd Ste AFort Wayne, IN 46804-4138 · (260) 999-6924 · Fax (260) 222-2844
Phone(260) 999-6924
Fax(260) 222-2844
Organization SubpartNo
Authorized OfficialVishaal VeerulaOwner · (260) 999-6924
Enumeration DateMay 27, 2022
NPPES CertifiedMay 27, 2022
✔ NPI 1528707619 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
7802 W JEFFERSON BLVD STE A, Fort Wayne, IN 46804
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 15D2268801

Fort Wayne Primary Care · Fort Wayne, IN
Active · expires Sep 15, 2026
CLIA Number15D2268801
Laboratory TypePhysician Office
Certificate Effective DateSeptember 16, 2024
Certificate Expiration DateSeptember 15, 2026
Laboratory DirectorVishaal Veerula
Laboratory Phone(260) 999-6924
Laboratory LocationFort Wayne Primary Care7802 West Jefferson Suite A, Fort Wayne, IN 46804
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JAMES D KIM MD
Ophthalmology
7802 W JEFFERSON BLVD STE A
FORT WAYNE, IN 46804
Allen County (260) 305-2822
FT WAYNE CARDIAC INTEGRATIVE AND PRIMARY CARE LLC
Internal Medicine
7802 W JEFFERSON BLVD STE A
FORT WAYNE, IN 46804
Allen County (260) 999-6924
DR. MOHAMED G GENDY M.D.
Ophthalmology
7802 W JEFFERSON BLVD STE A
FORT WAYNE, IN 46804
Allen County (260) 305-2822
INDIANA RETINA CENTER LLC
Ophthalmology (Retina Specialist)
7802 W JEFFERSON BLVD STE A
FORT WAYNE, IN 46804
Allen County (260) 305-2822

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fort Wayne Primary Care LLC's NPI number?

The NPI number for Fort Wayne Primary Care LLC is 1528707619. It was assigned to this organization in the NPPES registry on May 27, 2022.

Where is Fort Wayne Primary Care LLC located?

Fort Wayne Primary Care LLC is located at 7802 W Jefferson Blvd Ste A, Fort Wayne, IN 46804. The listed phone number is (260) 999-6924.

What is Fort Wayne Primary Care LLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Fort Wayne Primary Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D2268801) is associated with this NPI, valid through September 15, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Fort Wayne Primary Care LLC accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan and Ambetter from Meridian list Fort Wayne Primary Care LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Fort Wayne Primary Care LLC was last updated on May 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.